Preferences for COVID-19 vaccination information and location: Associations with vaccine hesitancy,race and ethnicity

This study examined the association between preferences for being informed about the COVID-19 vaccine and where to receive it with vaccination intent and race/ethnicity. We conducted an online survey, oversampling Black and Latino panel members. The 1668 participants were 53.2% female, 34.8% White, 33.3% Black, and 31.8% Latino. Participants who were vaccine hesitant (answered “not sure” or “no” to vaccination intent) were more likely to prefer a conversation with their doctor compared to those who answered “yes” (25.0% and 23.4% vs 7.8%, P < .001, respectively). Among participants who responded “not sure”, 61.8% prefer to be vaccinated at a doctor’s office, compared with 35.2% of those who responded “yes” (P < .001). Preferred location differed by race/ethnicity (P < .001) with 67.6% of Black “not sure” participants preferring a doctor’s office compared to 60.2% of Latino and 54.9% of White “not sure” participants. These findings underscore the need to integrate healthcare providers into COVID-19 vaccination programs.     

A cross-sectional analysis of trust of information and COVID-19 preventative practices among people with disabilities

BackgroundTrust of information shapes adherence to recommended practices and speed of public compliance during public health crises. This is particularly important for groups with higher rates of high-risk health conditions, including those aged 65 and over and people with disabilities.ObjectiveWe examined trust in information sources and associated adherence to COVID-19 public health recommendations among people with disabilities living in metropolitan, micropolitan, and noncore counties.MethodsWe recruited participants using Amazon’s Mechanical Turk (MTurk) and screened for disability status (n = 408). We compared sociodemographic groups with t-tests, Pearson’s correlations, and Chi-square, as appropriate. We used linear regression to examine factors associated with trust in information and compliance with CDC recommended COVID-19 practices.ResultsNonmetro respondents had the lowest trust ratings among all demographic groups, and reported significantly less trust in most information sources. Respondents aged 65 and over reported the highest compliance with CDC recommended practices, while those from nonmetro areas reported the lowest. A regression model for adherence to CDC recommended practices was significant (F = 11.87, P ≤ .001), and explained 33% of the variance. Specifically, increased adherence was associated with being over 65, female, and higher general trust scores. Decreased practices were associated with being nonwhite, nonmetro, higher trust scores in President Trump, and having a communication disability.ConclusionsTrust in information sources is associated with action. It is important to provide clear, consistent, and non-polarizing messages during public health emergencies to promote widespread community action.     

Factors affecting COVID-19 vaccine hesitancy among healthcare providers in 23 countries

BackgroundSeveral early COVID-19 studies aimed to assess the potential acceptance of a vaccine among healthcare providers, but relatively few studies of this population have been published since the vaccines became widely available. Vaccine safety, speed of development, and low perceived disease risk were commonly cited as factors for COVID-19 vaccine hesitancy among this group.Purpose and methodsIn a secondary analysis based on a cross-sectional, structured survey, the authors aimed to assess the associations between self-reported vaccine hesitancy and a number of sociodemographic and COVID-19 vaccine perception factors using data from 3,295 healthcare providers (physicians, nurses, community health workers, other healthcare providers) in 23 countries.Findings494 (15.0%) of the participants reported vaccine hesitancy, of whom 132 (4.0%) would outright refuse to accept a COVID-19 vaccine. Physicians were the least hesitant. Vaccine hesitancy was more likely to occur among those with less than the median income and, to a lesser degree, younger age. Safety and risk concerns and lack of trust that vaccines would be equitably distributed were strongly associated with hesitancy, less so were concerns about the efficacy of COVID-19 vaccines.InterpretationFindings suggest a need to address safety and risk concerns through tailored messaging, training, and/or incentive approaches among healthcare providers, as well as the need for international and national vaccination efforts to ensure equitable distribution.     

Factors associated with COVID-19 vaccination intentions among adults in the deep South

The recent approval of several COVID-19 vaccines signals progress toward controlling the pandemic. Although social distancing and masking have been effective, vaccines are an important additional measure of protection to reduce COVID-19 spread. Adequate uptake is essential to reach herd immunity, estimated to be approximately 67%. However, vaccine hesitancy, the fast-tracked nature of the COVID-19 vaccines, and misinformation circulating through various forms of media have contributed to lower vaccination intention than desired. The current research study developed an online survey conducted via Facebook to explore the attitudes and perceptions of adult Alabama residents about COVID-19 and the COVID-19 vaccines. Of the 3,781 respondents, only 44.3% reported intent to receive a vaccine, with a large proportion reporting they were unsure (28.1%). Lack of intention to vaccinate was associated with low educational attainment, low COVID-19 knowledge levels, low income, and African American race. The current survey also explored participants’ influenza vaccine behavior as this information can also be used to inform successful COVID-19 vaccine distribution. Of the respondents, 56% report receiving the yearly influenza vaccine and the majority receive it at a pharmacy or healthcare provider office. This informs likely successful locations for COVID-19 vaccine distribution. Appropriate education targeted to populations most likely to refuse COVID-19 vaccination is essential to promote uptake. The information collected from the current study should be utilized to inform effective and efficient vaccine distribution strategies.     

Self-reported COVID-19 vaccination acceptance and hesitancy among autistic adults

Identifying factors associated with COVID-19 vaccination acceptance among vulnerable groups, including autistic individuals, can increase vaccination rates and support public health. The purpose of this study was to determine differences among autistic adults who reported COVID-19 vaccination acceptance from those who did not. In this study we describe COVID-19 vaccination status and self-reported preferences among autistic adults and identify related factors. Vaccine accepters were more likely to report increased loneliness during COVID-19, lived in more populous counties (p = 0.02), and lived in counties won by President Biden in the 2020 US presidential election (p < 0.001). Positive correlations were found between desire to protect others, concern about contracting COVID-19, and trusting vaccine safety (p < 0.001). Concern about vaccine safety was common among the vaccine hesitant, while lack of concern about COVID-19 overall was not. Identifying health promotion strategies based on self-reported, lived experiences about COVID-19 among vulnerable groups is key for public health impact.     

Person-reported perspectives on support availability for people with disabilities during the COVID-19 pandemic in Quebec

ObjectivesTo identify the perception of the availability of community support and the support needs of autistic people and people with disabilities, from their own perspectives and from those of their caregivers at the time of the COVID-19 pandemic in Quebec, to assess the association between the available support and the perceived stress levels to evaluate the role of perceived social support as a potential buffer of this association.MethodsA total of 315 respondents participated in a 4-min online survey across the province of Quebec by snowball sampling. Community support was defined as availability of adapted healthcare, adapted information, adapted educational services and community services.ResultsThe community support and services during the COVID-19 pandemic were not available or were not sufficiently adapted to their needs. About 40% of autistic people or people with disabilities and 44% of their caregivers perceived their days as being quite stressful or extremely stressful. This is twice the rate of that of the general population in non-pandemic time. Nevertheless, social supports can play a mediating role in attenuating the effects of the absence of adapted services on the stress level of this vulnerable population.ConclusionThe non-availability of adapted services was related to an increase in the stress level in this population. Our study adds that other than social support, adapted healthcare/tele-healthcare and in-home support services could reduce the impact of the pandemic on the stress level of autistic people and people with disabilities. Adapted educational services and necessary equipment for online education for people without resources could reduce the impact on the stress level in caregivers. People with disabilities and their caregivers are one of the most vulnerable groups in our society. Public health measures of containment and mitigation need to consider more their specific needs.     

Unravelling the drivers behind COVID-19 vaccination hesitancy and refusal among teachers: A nationwide study

This study aims to assess the determinants of the coronavirus disease 2019 (COVID-19) vaccination hesitancy and refusal (VHR) among teachers, from pre-school to higher education, through an online survey. A logistic regression analysis was used to determine the adjusted odds ratio (OR) of the independent variables (perceptions, knowledge, and attitudes) per 1-point increase in the Likert scale, and VHR.Concerns about the vaccines’ efficacy and safety increase the risk of VHR (OR = 6.97, 95 %CI: 4.82–10.09 and OR = 8.71, 95 %CI: 5.52–13.73, respectively). Higher risk perceptions of getting infected (1/OR = 3.94, 95 %CI: 2.93–5.29), trust in the effectiveness of vaccines in reducing this risk or protecting against suffering complications (OR = 3.52, 95 %CI: 2.72–4.55 and OR = 10.94, 95 %CI: 7.16–16.68, respectively), and higher trust levels on the information transmitted regarding COVID-19 vaccination, are associated to lower VHR.As VHR appears to be highly influenced by perceptions, knowledge, and attitudes, it is crucial to promote and design interventions targeted to transforming these determinants.     

The public health response to the COVID-19 pandemic for people with disabilities

With the rapidly changing landscape of the COVID-19 outbreak, how to best address the needs and continue to protect the health and well-being of people with disabilities (PwDs) is a global public health priority. In this commentary we identify three public health areas of ongoing need and offer possible strategies to address each. These areas include: the types of data that would help clarify risks for PwDs and help assure their safety long term; the prevention, treatment and mitigation measures for PwDs that are needed through the duration of the outbreak; and the issues of equity in access to and quality of medical care for PwDs. Because of the rapid nature of the public health response, it is critical to reassess and readjust our approach to best address the needs of PwDs in the months and years to come and to incorporate these new practices into future emergency preparedness responses.     

Vaccination willingness,vaccine hesitancy,and estimated coverage at the first round of COVID-19 vaccination in China: A national cross-sectional study

BackgroundVaccination against coronavirus disease 2019 (COVID-19) has become an important public health solution. To date, there has been a lack of data on COVID-19 vaccination willingness, vaccine hesitancy, and vaccination coverage in China since the vaccine has become available.MethodsWe designed and implemented a cross-sectional, population-based online survey to evaluate the willingness, hesitancy, and coverage of the COVID-19 vaccine among the Chinese population. 8742 valid samples were recruited and classified as the vaccine-priority group (n = 3902; 44.6%) and the non-priority group (n = 4840; 55.4%).ResultsThe proportion of people’s trust in the vaccine, delivery system, and government were 69.0%, 78.0% and 81.3%, respectively. 67.1% of the participants were reportedly willing to accept the COVID-19 vaccination, while 9.0% refused it. 834 (35.5%) reported vaccine hesitancy, including acceptors with doubts (48.8%), refusers (39.4%), and delayers (11.8%). The current coverage was 34.4%, far from reaching the requirements of herd immunity. The predicted rate of COVID-19 vaccination was 64.9%, 68.9% and 81.1% based on the rates of vaccine hesitancy, willingness, and refusal, respectively.ConclusionsThe COVID-19 vaccine rate is far from reaching the requirements of herd immunity, which will require more flexible and comprehensive efforts to improve the population’s confidence and willingness to vaccinate. It should be highlighted that vaccination alone is insufficient to stop the pandemic; further efforts are needed not only to increase vaccination coverage but also to maintain non-specific prevention strategies.     

Determinants of COVID-19 vaccine hesitancy and resistance in Russia

Vaccination is the main tool available to handle the COVID-19 pandemic globally. Though no vaccine is proven to be 100% effective, vaccination secures against getting seriously ill and dying from the disease. Russia announced the development of its first domestic vaccine back in August 2020 and launched the nationwide immunization campaign at the beginning of 2021. Despite these achievements, as of mid-October 2021, only 36% of the population got at least one shot of the vaccine. Massive vaccination hesitancy and refusal pose a great threat to public health and postpone social and economic recovery. Using nationally representative data from the general adult population of Russia, this study explores the scope of vaccination hesitancy and refusal as well as the determinants of vaccination attitudes. The results suggest that only 45% of the Russian population demonstrated positive attitudes towards the COVID-19 vaccination prior to the launch of a nationwide vaccination program. We analyze a wide array of demographic, socio-economic, and health-related factors in relation to vaccination intentions and explore the deep-rooted causes of vaccination reluctance by looking at personality traits, religiosity, and trust. The obtained results are vital for designing policy measures to promote vaccination.     

COVID-19 vaccine hesitancy cannot fully explain disparities in vaccination coverage across the contiguous United States

Vaccine hesitancy has been identified as a major obstacle preventing comprehensive coverage against the COVID-19 pandemic. However, few studies have analyzed the association between ex-ante vaccine hesitancy and ex-post vaccination coverage. This study leveraged one-year county-level data across the contiguous United States to examine whether the prospective vaccine hesitancy eventually translates into differential vaccination rates, and whether vaccine hesitancy can explain socioeconomic, racial, and partisan disparities in vaccine uptake. A set of structural equation modeling was fitted with vaccine hesitancy and vaccination rate as endogenous variables, controlling for various potential confounders. The results demonstrated a significant negative link between vaccine hesitancy and vaccination rate, with the difference between the two continuously widening over time. Counties with higher socioeconomic statuses, more Asian and Hispanic populations, more elderly residents, greater health insurance coverage, and more Democrats presented lower vaccine hesitancy and higher vaccination rates. However, underlying determinants of vaccination coverage and vaccine hesitancy were divergent regarding their different associations with exogenous variables. Mediation analysis further demonstrated that indirect effects from exogenous variables to vaccination coverage via vaccine hesitancy only partially explained corresponding total effects, challenging the popular narrative that portrays vaccine hesitancy as a root cause of disparities in vaccination. Our study highlights the need of well-funded, targeted, and ongoing initiatives to reduce persisting vaccination inequities.     

COVID-19 differentiated measures for unvaccinated individuals: The need for clear goals and strong justifications

Numerous countries and jurisdictions have implemented differential COVID-19 public health restrictions based on individual vaccination status to mitigate the public health risks posed by unvaccinated individuals. Although it is scientifically and ethically justifiable to introduce such vaccination-based differentiated measures as a risk-based approach to resume high-risk activities in an ongoing pandemic, their justification is weakened by lack of clarity on their intended goals and the specific risks or potential harms they intend to mitigate. Furthermore, the criteria for the removal of differentiated measures may not be clear, which raises the possibility of shifting goalposts without clear justification and with potential for unfairly discriminatory consequences. This paper seeks to clarify the ethical justification of COVID-19 vaccination-based differentiated measures based on a public health risk-based approach, with focus on their deployment in domestic settings. We argue that such measures should be consistent with the principal goal of COVID-19 vaccination programmes, which is to reduce the incidence of severely ill patients and associated healthcare burdens so as to protect a health system. We provide some considerations for the removal of vaccination-based differentiated measures based on this goal.     

Hesitation of the Tunisian population to COVID-19 vaccination,and its associated factors

Background: Many people are reluctant to be vaccinated against COVID-19. Aim: To determine the intention to accept COVID19 vaccine and its associated factors among Tunisians. Methods: We conducted a cross-sectional study among Tunisians from December 2020 to January 2021 using an online questionnaire. Factors associated with intention to accept coronavirus vaccine were analysed using multinomial logistic regression. Results: In total, 169 Tunisians participated in our study. The majority were female (85.2%). The mean age was 48.3 ± 11.8 years. Only 33.1% intended to accept to be vaccinated when COVID-19 vaccine will be available in Tunisia and 22.5% were still hesitant. In multinomial logistic regression, participants having high or very high perceived personal risk of COVID-19 infection (aOR:3.257, 95% CI :1.204 – 8.815) were more prone to hesitate to accept COVID-19 vaccine rather than those being willing to accept it. Respondents undergoing seasonal influenza vaccination (aOR: 0.091, 95% CI : 0.019 – 0.433)were less prone to refuse COVID-19 vaccine rather than those being willing to accept it. Young ones aged less than 40 years (aOR: 4.324, 95% CI: 1.180 – 15.843) were more prone to refuse COVID-19 vaccine rather than those being willing to accept it. Conclusion: The acceptance rate of coronavirus vaccination was moderate. Therefore, a good communication and health education at a community level are needed.     

Longitudinal change in depressive symptoms among healthcare professionals with and without COVID-19 vaccine hesitancy from October 2020 to June 2021 in Japan

This study aimed to compare the longitudinal change in depressive symptoms among healthcare professionals in Japan who are willing to receive novel coronavirus disease (COVID-19) vaccination and those who are unwilling to receive COVID-19 vaccination. The baseline survey was conducted in October 2020 (Survey time 1: T1); respondents in T1 were invited to participate in May 2021 (Survey time 2: T2). Depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ-9). Group comparisons of the estimated mean of PHQ-9 score at T1 and T2 were estimated by the analysis of covariance. In T1, 597 participants (response rate: 4.4%) completed all questions. In T2, 211 participants (follow up rate: 35.3%) completed all questions. The group and time interaction effect was significant (F(1, 207)=3.9, p=0.049); depressive symptoms were worse among healthcare professionals who were unwilling to receive vaccination than among those who were willing to receive vaccination. This study showed that depressive symptoms were worse among healthcare professionals who were unwilling to receive COVID-19 vaccination than those who are willing to receive COVID-19 vaccination. This suggests that it is important to take care of healthcare professionals who are unwilling to receive vaccination to prevent mental health deterioration.     

Misinformation and COVID-19 vaccine hesitancy

BackgroundCOVID-19 vaccine hesitancy has emerged as a major public health challenge. Although medical and scientific misinformation has been known to fuel vaccine hesitancy in the past, misinformation surrounding COVID-19 seems to be rampant, and increasing evidence suggests that it is contributing to COVID-19 vaccine hesitancy today. The relationship between misinformation and COVID-19 vaccine hesitancy is complex, however, and it is relatively understudied.MethodsIn this article, we report qualitative data from two related but distinct studies from a larger project. Study 1 included semi-structured, open-ended interviews conducted in October–November 2020 via phone with 30 participants to investigate the relationship between misinformation and COVID-19 vaccine hesitancy. Study 1′s results then informed the design of open-ended questions for Study 2, an online survey conducted in May–June 2021 to consider the relationship between misinformation and vaccine hesitancy further. The data were examined with thematic analysis.ResultsStudy 1 led to the identification of positive and negative themes related to attitudes toward COVID-19 vaccines. In Study 2, responses from vaccine-hesitant participants included six categories of misinformation: medical, scientific, political, media, religious, and technological. Across both Study 1 and Study 2, six vaccine hesitancy themes were identified from the data: concerns about the vaccines’ future effects, doubts about the vaccines’ effectiveness, commercial profiteering, preference for natural immunity, personal freedom, and COVID-19 denial.ConclusionsThe relationship between misinformation and vaccine hesitancy is complicated. Various types of misinformation exist, with each related to a specific type of vaccine hesitancy-related attitude. Personal freedom and COVID-19 denial are vaccine attitudes of particular interest, representing important yet understudied phenomena. Medical and scientific approaches may not be sufficient to combat misinformation based in religion, media, or politics; and public health officials may benefit from partnering with experts from those fields to address harmful misinformation that is driving COVID-19 vaccine hesitancy.